The National Diabetes Inpatient Audit – Harms (NaDIA-Harms) is a continuous collection of serious inpatient harms that affect people with diabetes. Data collection began on 1 May 2018. The 2019 report covers NaDIA-Harms data collected between May 2018 and October 2019.

All acute hospitals in England should take part in the audit to help reduce the rates of serious inpatient harms by informing their quality improvement work.

Serious inpatient harms affecting people with diabetes

NaDIA-Harms monitors four uncommon complications which might happen to people with diabetes during an inpatient stay:

- **Hypoglycaemic rescue** – low blood glucose levels causing harm and requiring injectable rescue treatment.
- **Hyperglycaemic emergencies** – dangerously high blood glucose levels:
  - **Diabetic Ketoacidosis (DKA)** – Mainly type 1 diabetes.
  - **Hyperosmolar hyperglycaemic state (HHS)** – Mainly type 2 diabetes.
- **Hospital acquired inpatient diabetic foot ulcer (DFU)**

### Trust participation

Since collection started on 1 May 2018:

- **131** (76%) NHS trusts are known to be eligible for NaDIA-Harms
- **100** (51%) NHS trusts have submitted to NaDIA-Harms
- **51** (39%) NHS trusts regularly submit to NaDIA-Harms

Using estimates derived from the 2019 NaDIA snapshot, case ascertainment in NaDIA-Harms ranges from 6 (diabetic foot ulcer) to 20 per cent (DKA).

### Type of inpatient harm

- **2,055** The majority of submitted harms were hypoglycaemic rescue
- **440** DKA
- **80** HHS
- **330** DFU

Counts of harms are rounded to the nearest 5

### High risk characteristics

Higher risk characteristics found for all three inpatient harms tested were:

- **White ethnicity**
- **Longer diabetes duration**
- **Missing treatment targets and care processes**
- **Emergency admission**
- **Higher HbA1c and cholesterol**
- **Complications during admission:** Admitted with foot disease, RRT required during admission

**Note:** 1. HHS was excluded due to the small number of episodes reported (80).

### The audit recommends...

- **Acute hospitals** should all participate in NaDIA-Harms.
- **Healthcare professionals** should be aware of the increased risk of harm in hospital inpatients with higher risk characteristics.